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Ferreira MY, Gunkan A, Batista S, Porto M, Camerotte R, de Barros Oliveira L, Porto Junior S, Okoye O, da Fonseca IO, Bertani R, Tanus Machado EA, Ferreira C, Langer D, Ciccio G, Serulle Y. Feasibility, safety, and efficacy of endovascular treatment of anterior cranial fossa dural arteriovenous fistulas: a systematic review and meta-analysis with a subanalysis for Onyx. Neurosurg Rev 2024; 47:217. [PMID: 38736006 DOI: 10.1007/s10143-024-02446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT's role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger's test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.
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Affiliation(s)
| | - Ahmet Gunkan
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Savio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mauricio Porto
- Faculty of Medicine, Salvador University, Salvador, Bahia, Brazil
| | - Raphael Camerotte
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Obiora Okoye
- Sub-Saharan Africa Brain Health Initiative (SSABHI), Abuja, Nigeria
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - David Langer
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Gabriele Ciccio
- Department of Radiology, CHU de Saint Etienne, Saint Etienne, France
| | - Yafell Serulle
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
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Rathnakara SH, Suresh A, Subramaniam V. Endoscopic Management of Ethmoidal Schwannoma: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:723-726. [PMID: 37206717 PMCID: PMC10188753 DOI: 10.1007/s12070-022-03238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Schwannomas of sinonasal origin are rare tumours with an incidence as low as 4% and may present with a wide range of clinical features. Due to non-specific endoscopic and radiological findings, diagnosis becomes difficult. We present a case of an ethmoidal schwannoma with nasal and nasopharyngeal extension in an elderly female patient who had a slow course of the long-standing disease. Her main complaints were nasal obstruction, nasal discharge, mouth breathing, snoring and recurrent nasal bleed. Nasal endoscopy showed a pale, firm, polypoidal mass with dilated vessels on the surface which bled on probing. It was a non-enhancing sinonasal mass with scalloping of adjacent paranasal sinuses and erosion of posterior nasal septum on contrast-enhanced computed tomography. Endoscopic excision of the mass was done in toto and histopathology report confirmed it as schwannoma. Long standing sinonasal masses especially in the elderly age group with an indolent medical history should arise suspicion of benign neoplasm especially schwannomas due to their high rate of incidence amongst benign sinonasal neoplasms.
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Affiliation(s)
| | - Arjun Suresh
- Yenepoya Medical College, Mangalore, Karnataka India
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Delavari N, Staffenberg D, Riina H. Transpalpebral Incision for Resection of an Ethmoidal Dural Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E606. [PMID: 32674152 DOI: 10.1093/ons/opaa213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
Ethmoidal dural arteriovenous fistulas are vascular malformations with arterial supply from the anterior ethmoidal artery and ultimate drainage into the sagittal sinus.1-3 They are characterized by a high risk of hemorrhage. Microsurgical disconnection of the fistula represents a safe and robust treatment option. Endovascular treatment requires catheterization of the ophthalmic artery and carries a risk of visual deficits. The supraorbital craniotomy provides an excellent corridor to the anterior skull base and is well suited for the treatment of ethmoidal dural arteriovenous fistulas. The supraorbital craniotomy may be performed through a transpalpebral "eyelid" incision. The transpalpebral incision allows for a well-hidden scar and does not have any associated hair loss, as can be seen with the eyebrow incision. The patient consented to the procedure and being videotaped.
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Affiliation(s)
- Nader Delavari
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - David Staffenberg
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Howard Riina
- Department of Neurosurgery, New York University School of Medicine, New York, New York
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Dabus G, Kan P, Diaz C, Pabon B, Andres-Mejia J, Linfante I, Grossberg JA, Howard BM, Islak C, Kocer N, Kizilkilic O, Puri AS, Kuhn AL, Moholkar V, Ortega-Gutierrez S, Samaniego EA, McDermott MW. Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series. Neuroradiology 2020; 63:259-266. [PMID: 32840681 DOI: 10.1007/s00234-020-02536-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We report a multicenter experience using endovascular embolization as the first line approach for treatment of anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF). METHODS All patients with DAVFs located in the anterior cranial fossa who were treated with endovascular technique as a first line approach were included. Demographics, clinical presentation, angioarchitecture, strategy, complications, immediate angiographic, and follow-up results were included in the analysis. RESULTS Twenty-three patients met the inclusion criteria (18 male and 5 female). Age ranged from 14 to 79 years (mean 53 years). Twelve patients presented with hemorrhage. Twenty-eight endovascular procedures were performed. The overall immediate angiographic cure rate after endovascular treatment was 82.6% (19/23 patients). The angiographic cure rate of the transvenous strategy was significantly superior to the transarterial strategy (p ≤ 0.001). There was 1 complication in 28 total procedures (3.6%). Angiographic follow-up was available in 21 out of the 23 patients with a mean of 25 months (range 2 to 108 months). In these 21 patients, the DAVF was completely cured in 20 (95%). At last follow-up, all patients had a modified Rankin scale (mRS) 0 to 2. CONCLUSION Our experience suggests that endovascular treatment for ACF DAVFs has an acceptable safety profile with high rates of complete occlusion, particularly with transvenous approach. Whenever possible, transvenous approach should be preferred over transarterial approach as first line strategy.
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Affiliation(s)
- Guilherme Dabus
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA.
- Miami Cardiac & Vascular Institute, 8900 N. Kendall Drive, Miami, FL, 33176, USA.
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Carlos Diaz
- Interventional Neuroradiology at Incare, Universidad de Antioquia, Medellin, Colombia
| | - Boris Pabon
- Interventional Neuroradiology at Angioteam, Medellin, Colombia
| | | | - Italo Linfante
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA
| | | | - Brian M Howard
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Civan Islak
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Naci Kocer
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | - Anna L Kuhn
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | - Viraj Moholkar
- Department of Radiology, University of Massachusetts, Worcester, MA, USA
| | | | - Edgar A Samaniego
- Department of Neurology and Radiology, University of Iowa, Iowa City, IA, USA
| | - Michael W McDermott
- Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Neuroscience Institute - Baptist Hospital, Miami, FL, USA
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Kulanthaivelu K, Pendharkar H, Prasad C, Kumar Gupta A, Hanumanthapura Ramalingaiah A, Saini J, Srinivas D. Anterior Cranial Fossa Dural Arteriovenous Fistulae - Angioarchitecture and Intervention. Clin Neuroradiol 2021; 31:661-9. [PMID: 32666243 DOI: 10.1007/s00062-020-00932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVF) are rare, unique, and ominous. While surgical disconnection is considered as the favored management option, endovascular treatment has lately gained importance. We present a single institution experience of seven cases. METHOD A retrospective analysis was performed on the institutional patient database. Features analyzed were demographic details, symptoms, angioarchitecture, treatment course, angiographic results, procedural complications, and follow-up. RESULTS This study included seven patients. The age at presentation ranged from 5-67 years. Clinical symptomatology was as intracranial hemorrhage in 4 patients and headache, chemosis and seizures in one patient each. The fistulae were paramedian at the ACF base. All DAVFs were Cognard type 4. The arterial feeders were from the anterior ethmoidal branches of the ophthalmic artery in all cases (bilateral in n = 5), frontal branches of the middle meningeal artery (MMA) (n = 6), and multiple ECA branches. The arterial route was the choice for access. Complete fistula obliteration was achieved in all but one patient. A traversed vein underwent rupture in one patient. One patient suffered postsurgical hemorrhage. No clinical or angiographic recurrence was noted. CONCLUSION The DAVFs of the ACF are inherently high-grade lesions. Transorbital ECA-ICA branch anastomoses may be recruited as feeders. They may be best managed by multidisciplinary means personalized on an angioarchitectural basis. Endovascular embolization is safe and efficacious when performed through a navigable feeder from the frontal division of the MMA, which according to our interpretation is in anastomosis with the anterior falcine branch of the anterior ethmoidal artery.
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Hendricks BK, Spetzler RF. Frontal Ethmoidal Dural Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E46. [PMID: 32171010 DOI: 10.1093/ons/opaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
Anterior cranial fossa dural arteriovenous fistulas (DAVFs) are an infrequent subtype of cranial DAVFs. These lesions are most commonly derived from the ophthalmic artery. These lesions are often best treated utilizing endovascular embolization; however, this modality can be challenging because of the difficulty in catheterizing the ophthalmic or ethmoidal arteries. Surgical intervention is therefore indicated and requires approaching the proximal portion of the drainage vein to appropriately obliterate the fistulous point. For ethmoidal DAVFs, this is frequently along the dura of the cranial base adjacent to the cribriform plate. This patient had a right frontal hematoma with a typical ethmoidal DAVF. The fistula was exposed through a frontal craniotomy, and the ethmoidal branch was identified at the fistulous point. Intraoperative angiography was used to test for obliteration, which revealed a contralateral DAVF. The contralateral fistula was then obliterated in a similar manner, demonstrated on a second intraoperative angiogram. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Gras-Cabrerizo JR, García-Garrigós E, Montserrat-Gili JR, Gras-Albert JR, Mirapeix-Lucas R, Massegur-Solench H, Quer-Agusti M. Anatomical Correlation Between Nasal Vascularisation and the Design of the Endonasal Pedicle Flaps. Indian J Otolaryngol Head Neck Surg 2017; 70:167-173. [PMID: 29456964 DOI: 10.1007/s12070-017-1197-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022] Open
Abstract
Arteries that supply the nasal septum and the lateral nasal wall include vessels that originate from the external carotid artery and from the internal carotid artery. A variety of local endonasal pedicle flaps can be used in different anatomical areas for endoscopic skull base reconstruction. The main flaps are based on terminal branches of the sphenopalatine artery and on anterior ethmoidal artery. This study will describe the anatomy of these vessels and their relationship with the main flaps.
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Affiliation(s)
- Juan R Gras-Cabrerizo
- 1Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena García-Garrigós
- 2Department of Radiology, Hospital Universitario de Alicante, Universidad Miguel Hernandez, Alicante, Spain
| | - Joan R Montserrat-Gili
- 1Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan R Gras-Albert
- 3Department of Otolaryngology/Head and Neck Surgery, Hospital Universitario de Alicante, Universidad Miguel Hernandez, Alicante, Spain
| | - Rosa Mirapeix-Lucas
- 4Unit of Anatomy and Human Embriology, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Humbert Massegur-Solench
- 1Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer-Agusti
- 1Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gross BA, Moon K, Kalani MYS, Albuquerque FC, McDougall CG, Nakaji P, Zabramski JM, Spetzler RF. Clinical and Anatomic Insights From a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute. World Neurosurg 2016; 93:94-9. [PMID: 27241099 DOI: 10.1016/j.wneu.2016.05.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. METHODS We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. RESULTS In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. CONCLUSIONS Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.
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Affiliation(s)
- Bradley A Gross
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Karam Moon
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cameron G McDougall
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph M Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Magro E, Engel D, Bojanowski MW. Transfrontal sinus approach for an anterior cranial fossa, ethmoidal, dural arteriovenous fistula. Surg Neurol Int 2014; 5:172. [PMID: 25593756 PMCID: PMC4287921 DOI: 10.4103/2152-7806.146345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Ethmoidal dural arteriovenous fistulas (eDAVFs) are usually approached via a pterional or a frontal craniotomy. A more direct route to the fistula is possible through a purely transfrontal sinus approach. The aim of this report is to illustrate the interest of transsinus frontal approach for eDAVFs. Case Description: The transfrontal sinus approach is described and illustrated in a case of an ethmoidal arteriovenous fistula. This approach is the most direct when treating an eDAVF surgically, allowing preserving neural structures with minimal to no brain manipulation. Conclusion: For eDAVFs, the purely transfrontal sinus approach is highly worth considering in cases of large frontal sinuses.
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Affiliation(s)
- Elsa Magro
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Doortje Engel
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Montreal, Quebec, Canada
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